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02/25/2003 TUE 09:13 FAX 13232689572DK ENVIRONMENTAL Z002 <br />Tota of Caiiforniv—environmental Protadion Agancy �% <br />Form Approved OMB No. 2050-0039 (Expires 9.30-44} { See II-Foructions on back ( ge 6. Department of Toxic Su6:rnncr.s Ca�l- <br />Pieai4 prinl or typo. Farm designed For use on alil4 (12 -pi ifrr. <br />old <br />CO. -in <br />DO NOT WRITE BELOW THIS LINE. � <br />DT5C H0224 11/99I While: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAY, <br />EPA 8700-22 To: P.U. Box 30D0, Speramonta, CA 95b12 <br />UNIFORM HAZARDOUS "Generators US EPA ID No. Manifest Documen <br />GI f <br />WASTE <br />2. Page I <br />Infonnolion m lite shaded orao$ <br />is nae required by Federal law, <br />MANIFEST rf4d' <br />6 0 <br />ai <br />. 7 <br />3- Generaior's Nome and Moiling Address <br />A..Staie Manifest Document Number <br />Appliad A&Z-408pace S,t uc :Ur - Corpomt'ion <br />2829 <br />3437. South Ai��I pprt Ray Alta; . Len , K.. Kt4yawa <br />6cockWn '$1 <br />(Qj w ---- <br />f: CA 206 <br />B. State Gnnenaror'S ID <br />1. Generator's Phone f )-2JD9-Ai <br />- -` L3 <br />S. Transporter i Company Nome 6. US EPA ID Nnm6cr <br />C_ State Transporters ID [Reserved.] <br />Q i {� <br />ONE RM1`1T .K"UIMROI+T 1", �N(� "f I I <br />DpT spori8r.'t Phag(831) 637-8509 <br />7. Transporter 2 Company Name b. US EPA ID Numbor <br />E. SidleTronsporler's ID lResewed] ! <br />E L j <br />F. Transfsorter's PlsOne <br />9 pati i a 10. US FPA ID Number <br />' <br />G. State F cili 's 1D <br />3650 >3MT 26TH ST <br />LOS AN=LR8, CA 90023 C A T 0 8 0 0 3 _3(J <br />-161'a y's Phonn (323j.2G8-5056 <br />11. LIS DOT Description lincluding Proper Shipping Nome, Hazard Class, and ID Number] 12- Containers 13. Tato] IA. Uni- <br />_ No, <br />Type Ou,nIiy Wt/Voi I. Waste Number <br />❑N1760 ,.. PG 1I <br />62 (4 b Q F I f^ <br />(i <br />t Otisoria4�2 ` 00� <br />N <br />b. <br />Stole <br />E <br />i <br />1 <br />EPA161her- <br />AC.- <br />T <br />STOSe <br />0 <br />EPA/Cflhcr <br />jt <br />d- <br />State <br />EPA/Other <br />1 Additional Descriptions for Materials Listed Above - <br />K. Handling Codes For Wastes Listed Above <br />IWAAS-. #283-013-01 SRG#154 <br />C. <br />15. SpeciaTlfDn�}�prupj�hs�^l�$}rtt.$4'S' <br />r <br />Oft® Earth Si LV. Inc. /R,aban Chaysz 031.637:65091- <br />31.637:8509 '16- <br />16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of ihis consignment are Fully and acturolely de6Gri68tl above by proper chipping narne and are clossifiad, packed, <br />marked, labeled, in in For highway <br />and and art a respsscls proper condition Ironiport y according to apphca6le inicrnortanal <br />and notional gavernmmt rego'Intions. <br />If I am a large quonhir peneralor, I certify that I have a program in place to reduce the volumc and toxicity of wade <br />praclica6le and that I hove :elected the method o! treatment, dilposaI to <br />generated to tete degree I have determined to be econcmiccl iy <br />ma which the furore human <br />proctica6le sfarage, at currcmlly avoiloble minimizes prasanl and threat to healer, <br />and the env.ronmenll OR, iF I am o $malt quantity generator, I have made a good faith em <br />ort 10 minimize my waste generation and select the best waste maragement meihoc f4ce Is <br />available to me and that I can afford. <br />Printed/Typed Nayme`_.^ <br />L ►4 t-- e C�-iCi_2S <br />Si <br />Month Day r. <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Moleriols <br />If <br />A <br />A <br />[cd/Ty Nomy n to <br />Month y Ypc. <br />Dn <br />P <br />a <br />lg. Trons arisr 2 Acknowled ement of Recci s of Mciseriols <br />_ <br />T <br />Printed/Typed Name SignaturC <br />Month ❑Iny Yca� <br />R <br />79. Dticrepancy Indicolion Space <br />- <br />f <br />A <br />C <br />I <br />L <br />f <br />_ <br />20. Focili Owner or CS arplor Certification of rncci t of hazard—, materials 'd by this mo ' est exec i os naled in Item 19. <br />T <br />Y <br />Prinmd/Typed Name <br />Signature <br />nS Day Yar; <br />DO NOT WRITE BELOW THIS LINE. � <br />DT5C H0224 11/99I While: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAY, <br />EPA 8700-22 To: P.U. Box 30D0, Speramonta, CA 95b12 <br />